New York State Association for Mobility Management (NYSAMM)

Membership Application

Thank you for your interest in becoming a member of the New York State Association for Mobility Management (NYSAMM). NYSAMM strives to be recognized as a mobility leader at harnessing individual and community assets to collectively impact mobility services in New York State through: Advocacy; Leveraging Resources; Learning Communities; and Professional Development and Training. The purpose of the Association is to provide unity to its members and opportunities to network and share information and resources.

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* 1. Demographic Information of Member

Last Name

First Name

Organization

Title

Street Address

City

State

Zip

Phone Number

E-mail Address

Website URL

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* 2. Description of the services you/your organization provides

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* 3. Description of your geographic service area

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* 4. Indicate where you provide services (check all that apply)

Urban Area

Rural Area

Local

County

Regionally

State

National

Other (please specify)